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(1) Background: Evidence regarding Non-Alcoholic Fatty Liver Disease (NAFLD) diagnosis is limited in the context of patients with gallstone disease (GD). This study aimed to assess the predictive potential of conventional clinical and biochemical variables as combined models for diagnosing NAFLD in patients with GD. (2) Methods: A cross-sectional study including 239 patients with GD and NAFLD diagnosed by ultrasonography who underwent laparoscopic cholecystectomy and liver biopsy was conducted. Previous clinical indices were also determined. Predictive models for the presence of NAFLD stratified by biological sex were obtained through binary logistic regression and sensitivity analyses were performed. (3) Results: For women, the model included total cholesterol (TC), age and alanine aminotransferase (ALT) and showed an area under receiver operating characteristic curve (AUC) of 0.727 (p < 0.001), sensitivity of 0.831 and a specificity of 0.517. For men, the model included TC, body mass index (BMI) and aspartate aminotransferase (AST), had an AUC of 0.898 (p < 0.001), sensitivity of 0.917 and specificity of 0.818. In both sexes, the diagnostic performance of the designed equations was superior to the previous indices. (4) Conclusions: These models have the potential to offer valuable guidance to healthcare providers in clinical decision-making, enabling them to achieve optimal outcomes for each patient.
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INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is characterized by ectopic fat deposition in the liver. However, a recent classification of this condition, which also integrates the presence of coexisting metabolic disorders, termed Metabolic dysfunction Associated Fatty Liver Disease (MAFLD), has been proposed. NAFLD is increasingly common in early childhood, partly due to the increase in metabolic disease in this age. Thus, studying hepatic steatosis in the metabolic context has become important in this population as well. However, NAFLD, and thus MAFLD, diagnosis in children is challenging by the lack of non-invasive diagnostic tools comparable to the gold standard of hepatic biopsy. Recent studies have reported that the Pediatric Metabolic Index (PMI) could be a marker of insulin resistance and abnormal liver enzymes, but its association with NAFLD, MAFLD, or altered adipokines in these conditions has not been reported. The aim of this study is to evaluate the correlation between PMI with the diagnosis of NAFLD or MAFLD, together with serum levels of leptin and adiponectin, in school-age children. METHODS: A cross sectional study was carried out in two hundred and twenty-three children without medical history of hypothyroidism, genetic, or chronic diseases. Anthropometry, liver ultrasound, and serum levels of lipids, leptin, and adiponectin were evaluated. The children were classified as having NAFLD or non-NAFLD, and a subgroup of MAFLD in the NAFLD group was analyzed. The PMI was calculated by the established formulas for age and gender. RESULTS: PMI correlated positively with the presence and severity of NAFLD (r = 0.62, p<0.001 and r = 0.79, p<0.001 respectively) and with the presence of MAFLD (r = 0.62; p<0.001). Also, this index correlated positively with serum leptin levels (r = 0.66; p<0.001) and negatively with serum adiponectin levels (r= -0.65; p<0.001). PMI showed to be a good predictor for diagnosing NAFLD in school-age children when performing a ROC curve analysis (AUROC=0.986, p< 0.0001). CONCLUSION: PMI could be a useful tool for the early diagnosis of NAFLD or MAFLD in children. However, future studies are necessary to establish validated cut-off points for each population.
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Enfermedad del Hígado Graso no Alcohólico , Humanos , Niño , Preescolar , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Adipoquinas , Leptina , Adiponectina , Estudios Transversales , Índice de Masa CorporalRESUMEN
Background Adherence to type 2 diabetes management is defined as the extent to which the behaviour of a person matches the one recommended by health care professionals. Control of this disease depends on adherence to diabetes management, which includes monitoring blood glucose levels, adopting a healthy diet, exercising, taking medication, quitting smoking, and undergoing psychosocial care and periodic check-ups. This can also prevent health complications and reduce medical costs. Objective The objective of this study is to validate a culturally appropriate instrument directed towards the Mexican population that measures a patient's level of adherence to their type 2 diabetes mellitus management. Method The study design was cross-sectional. The instrument was applied individually (face to face researcher-assisted survey) by a member of the team. The study sample included 200 participants, which were attended at an outpatient clinic. To evaluate the psychometric validity of the scale we calculated response frequencies, the discrimination of items for extreme groups, the validity, and the internal reliability. The scale of adherence for complete management in patients with type 2 diabetes includes disease monitoring, complication prevention, and social support using questions and answers based on the Likert scale, corresponding to the 5 stages of the transtheoretical model. Main outcome measure The validity and internal reliability of the instrument to measure adherence to type 2 diabetes management, which proved to be justifiable and reliable with a Cronbach's alpha of 0.92 and a total explained variance of 65.03%. Results The instrument was composed of 29 items and 6 factors: adherence to medical Cronbach's alpha = 0.92 and dietary treatment Cronbach's alpha = 0.88, change in dietary habits Cronbach's alpha = 0.89, adherence to physical activity and exercise Cronbach's alpha = 0.84, social support Cronbach's alpha = 0.79, and prevention of complications Cronbach's alpha = 0.70. The instrument obtained a content validity index (I-CVI) of 0.9. Conclusion The proposed instrument, which includes factors that measure adherence in type 2 diabetes mellitus patient's management, using the transtheoretical model of behaviour change to simultaneously identify patient motivation to change their lifestyle, is valid and reliable.
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Diabetes Mellitus Tipo 2 , Estudios Transversales , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
Background Fibroblast growth factor 21 (FGF21) is considered an important regulator of lipid and glucose metabolism. However, the role of FGF21 in macronutrient intake and metabolic disease, particularly in pediatric population, still needs further clarification. This study aimed to evaluate the association of rs11665896 in the FGF21 gene with metabolic status and macronutrient intake in a cohort of Mexican children with obesity. Methods Eighty-four lean children and 113 children with obesity, from 8 to 11 years of age, were recruited. FGF21 rs11665896 was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Somatometric evaluations, nutrient intake, glucose, lipids, insulin and FGF21 serum levels were measured in the obesity group. Results The T allele of rs11665896 in the FGF21 gene was associated with obesity (odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.14-3.46; p = 0.0151). Subjects with obesity carrying the TT genotype consumed less lipids and more carbohydrates compared to other genotypes. Circulating FGF21 levels correlated negatively with carbohydrate intake (r = -0.232, p = 0.022) and positively with body weight (r = 0.269, p = 0.007), waist (r = 0.242, p = 0.016) and hip girth (r = 0.204, p = 0.042). FGF21 levels were lower in carriers of at least one T allele. Conclusions Genetic variants in FGF21 could influence metabolic status, food preferences and qualitative changes in nutritional behavior in children.